Laying the virtual bricks of the Commonwealth’s Health Connector

The Massachusetts Connector Authority was part of the landmark law passed by the Commonwealth in 2006, requiring that nearly every resident have health insurance. The law established an independent public authority, the Commonwealth Health Insurance Connector Authority, which offers the subsidized coverage and facilitates the selection and purchase of private insurance plans by individuals and small businesses.

If someone chooses not to obtain healthcare coverage, they’ll be assessed a fine, when they file their taxes.

Backers of the state-run system say there are several advantages to this managed marketplace, including lower insurance rates and increased clarity on the specifics of plans offered. Additionally, those enrolled in the Connector pay with before-tax money and they can take their coverage with them, even if they switch jobs or lose a job.

In order to facilitate this massive program, Massachusetts chose Perot Systems to operate the IT infrastructure and member support call centers. Perot Systems’ Tim Olivier, who serves as the chief operating officer of their healthcare group, spoke with CivSource to discuss the company’s work with the program.

“Our call center handles about 40,000 calls per month,” Mr. Olivier said in an interview. “And we’re not operating typical call centers. A big portion of what we do is answer questions and advice, which takes a different kind of training and a different level of program awareness. The state offers six different flavors designed to appeal to folks based on their age or employer preferences.”

In fact, 40 percent of those 40,000 calls per month are questions regarding enrollment. Perot Systems conveys information about how a person gets enrolled, and handles calls about the types of insurance plans available to people in Health Connector. “The centers also support four different languages with someone in-house, as well as an automated system that allows for over 100 different languages,” Mr. Olivier said.

But Perot Systems also handles the IT-side of things. Which means Perot handles the work flow management system, knowledge-based management system, billing system, as well as handles the Web site front-end and runs the interface for the state’s management information system (MIS).

According to Mr. Olivier, “Our billing system sends out about 60,000 invoices every month.”

The biggest challenge for Perot Systems, and the state of Massachusetts, was that it was a new program. “No one was quite sure what to expect in terms of volume or call center invoices,” Mr. Olivier pointed out. “It ramped up a little faster, to everyone’s delight, but membership was higher than most initially thought it would be. It put a strain on operations, but everyone handled it.”

Mr. Olivier said that “a little more than half [of the newly insured] ended up getting insurance on their own – not subsidized or through Medicaid – because of the marketing and user education material. It’s impressive.”

One of the key factors that has allowed Health Connector to be a working success, from Mr. Olivier’s point of view, is that the Commonwealth was dedicated to solving the problem of access. “They started in a better place than other states, in terms of uninsured, but they were also committed. As the IT partner that supports them, it makes things much easier when they know where they want to go.”

Moving forward, there is uncertainty about how healthcare may or may not be reformed. The Obama administration has indicated that they are looking closely at what Massachusetts has done, but critics argue it’s not a cookie-cutter solution. As for Perot Systems, Mr. Olivier said he knows of a few states who are looking to do something similar, but there’s still, “a lot of wait and see at the state level.”

“What Massachusetts has proven,” Mr. Olivier said, “is that it can be done, done well at a state level, and done fairly quickly.”